Impacts of tuberculosis services strengthening and the COVID-19 pandemic on case detection and treatment outcomes in Mimika District, Papua, Indonesia: 2014–2021

Abstract

Indonesia is a high-burden tuberculosis (TB) country with a wide case detection gap, exacerbated by the COVID-19 pandemic. We aimed to review the epidemiology of TB in a high-endemic setting of Indonesia before and during the implementation of health system strengthening activities for TB, including during the first two years of the COVID-19 pandemic. We analysed TB program data from Mimika District, Papua, Indonesia from 2014 to 2021. Health system strengthening activities to improve the programmatic management of TB were implemented from 2017 onwards. Activities included decentralization of TB services, training and mentoring of healthcare workers, improved screening for co-morbidities, and introduction and optimisation of Xpert testing in 2018. A total of 11,803 TB cases were notified to the Mimika District Health Office over eight years (2014–21). Between 2015 and 2019, there was a 67% increase in annual case notifications, an 89% increase in bacteriologically confirmed cases and the proportion of TB cases detected in primary care increased from 26% to 46%. In 2020, coinciding with the COVID-19 pandemic, investigation of people with presumptive TB fell by 38%, but the proportion of those tested with Xpert increased. TB case notifications decreased by 19% from 1,796 in 2019 to 1,461 in 2020, but then increased by 17% to 1,716 in 2021. Routine screening for co-morbidities (HIV, diabetes) among TB patients improved over time and was not affected by the pandemic. Treatment success overall was 71% and remained relatively unchanged. Loss to follow-up and death were 18% and 3.7% respectively. Improvements in TB case finding were observed over a period in which a range of health system strengthening activities were implemented. While COVID-19 had a negative impact on the TB program in Mimika District, there are encouraging signs of recovery. Further work is needed to improve TB treatment outcomes.

Spatio-temporal analysis of tuberculosis incidence in North Aceh District, Indonesia 2019-2021

“…The pandemic impacted the delivery of TB services, while TB patients avoided to go to the health care providers to limit their exposure to COVID-19. This weakening of the performance of the TB programme due to the damaging presence of COVID-19 has not only been reported in the current study area but also in Indonesia in general (Caren et al, 2022;Lestari et al, 2022;Utomo et al, 2022).…”

“…As a result, treatment became neglected as almost all resources in both health sectors and others activities focused on handling COVID-19. This condition made the reported TB case discovery spuriously decrease significantly ( Caren et al, 2022;Chan et al, 2021;Lestari et al, 2022;Utomo et al, 2022).…”

The Global Impact of COVID-19 on Tuberculosis: A Thematic Scoping Review, 2020-2023

“…Nineteen publications [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] focused on COVID-19's detrimental impacts on TB diagnosis, laboratory capacity and systems, and the supply chain.…”

“I pity the TB patient”: a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future

“… 7–10 Additionally, several studies of public HCFs in Indonesia have shown that investigation of presumptive TB cases decreased during the pandemic, along with TB case notification rates and TB treatment coverage. 11 12 In contrast, a study of private HCFs reported no major changes in the quality of tuberculosis care due to the COVID-19 pandemic. 13 This indicates that there are gaps in the direct experience of patients and health workers when accessing TB services during the pandemic.…”